CONVULSIONS.
The cause must be sought for before active treatment can be com menced; thus the presence of a mass of round-worms in the intestinal canal of a child will call for Santonin and a purgative. The convulsions arising in a patient suffering from advanced renal affection will demand the active treatment necessary for unemic poisoning. Epileptic convulsions will be best prevented by Bromides, &c. In the same way the reader will find, under Hysteria, Tetanus, Poisoning by Strychnine, Teething, Apoplexy, Alcoholism, Puerperal Convulsions, &c., the appropriate remedies men tioned by which the convulsions may be prevented or modified or rendered less frequent.
When called to see a patient labouring under an attack of convulsions without any apparent cause, the physician will have considerable difficulty in preventing himsell from acting under the impulse that he must do something. The position of " masterly inactivity " is the safest as regards drugs in a situation of this sort, where at the moment little can be deter mined about the causation or pathology of the symptoms. The patient should be placed in bed upon his back with his head and shoulders slightly raised and all constrictions about the neck, thorax, or abdomen removed. If the tongue be protruded, and in danger of being wounded by the closure of the teeth, a lemonade cork may be inserted between the upper and lower molar teeth on one side. Unless the convulsive movements be severe and liable to cause contusions of the limbs or scalp, restraint should not be resorted to. In a series of rapidly succeeding attacks the vapour of Nitrite of Amyl may be judiciously employed. Chloroform or Ether may be administered upon a sponge. or Chloral Hydrate may be given by the rectum. Heroic like blood-letting, are unjustifiable, except in puerperal cases.
Infantile Convulsions.—As a proportion of the cases of convulsions arising in infancy from delayed dentition, bowel or other passing troubles, tends to end in epilepsy in the children of neurotic parents, it is most desir able that careful attention should be given to the prevention of further attacks after the immediate attack has been treated.
During the seizure a warm but not hot bath should be immediately resorted to; if there be hyperpyrexia the water should be tepid. Ice may be applied to the head or a cold stream of water directed against the fontanelle, and a whiff of the vapour of Chloroform or of Amyl Nitrite may be given. The practice of injecting Hyoscine or Morphia hypodermically
has been advocated, but the physician will be wise who contents himself with the rectal administration of Chloral Hydrate and Bromides or with the use of these agents by the mouth as soon as the power of swallowing returns. 3 grs. chloral and to grs. bromide of soda may he injected into the rectum of a child six months old. The following may be given in teaspoonful doses by the mouth every 2 hours closes: Chloral Hydral. gr. xx.
Sodii Brom. gr. xl.
Phenazoni gr. x.
Syrujbi el Aquce ad 3ij. Misce.
The bowel in every case should be cleared out by a small dose of Calomel or Castor Oil.
A little blood may be let out from a vein in the arm where cyanosis is marked and persistent, but leeching is useless. In the asphyxial convul sions occurring at birth, bleeding from the cord may be permitted or a vein opened. When there are marked and persistent focal symptoms arising after a difficult delivery meningeal hiemorrhagc is probably present, and trephining may be justified in order to prevent permanent brain injury.
In all cases of infantile convulsions the bromide treatment should he continued long after the cessation of symptoms, and such children shoulu subsequently be carefully examined for adenoids, eye troubles, rickets, or other possible sources of reflex irritation which may tend to establish the epileptic condition.
The routine plan of scarifying the gums in every case of convulsions occurring in young children is a practice of the past. The tough cicatrix forming over the incisions afterwards, is generally the source of serious future trouble. The writer has seen the leathery gums of infants who had been subjected to wholesale scarifications months previously for supposed delayed dentition, when the cause of the convulsions was probably a mass of curd in the intestines, the result of indigestible cow's milk. When the tooth should be above the gum, these old, dense cicatrices so hold it down that the only course is to snip a piece out of the cicatricial tissue with scissors or a knife.
If the sterilised index-finger be cautiously introduced into the mouth of the infant any tooth near eruption may have the thinned gum tissue scraped by the finger-nail.